Promoting evidence-based practice in nursing education: the good behavior game as a pedagogical tool for student engagement

The delivery of quality healthcare to improve the work environment and patients' outcomes relies increasingly on evidence-based practices (EBP) (Abu-Baker et al., 2021; Smith, 2021), making it imperative for nurses to possess the expertise to seek pertinent and suitable information (Xia et al., 2023). This involves acquiring knowledge, comprehension, and proficiency to inform the care they administer (Ryan, 2016). In addition, recent calls to face the nursing shortage emphasize the importance of promoting evidence-based practice education (Whalen, 2023). Such focus on EBP in academia is expected to positively impact retention, nurse confidence, knowledge, stress, and job satisfaction, especially with new graduate nurses transitioning to work environments that pose pressures beyond those previously experienced (Whalen, 2023). This focus must be considered a priority in academia to ensure nursing workforce sustainability (Margolis et al., 2023).

The evidence shows that most nurses, nurse educators, and nursing students had reported no previous experience implementing or applying EBP-related skills (Cardoso et al., 2021; Duncombe, 2018; Pitsillidou et al., 2021). Although the skills related to employing EBP are crucial, there has been insufficient focus on incorporating them into undergraduate education. Thus, it is widely acknowledged that such education and developing interventions targeting EBP skills are vital for adequately preparing nurses for their professional careers (Cardoso et al., 2021; Ryan, 2016).

Integrating evidence-based practice into nursing curricula is crucial. This step is fundamental in preparing students for future roles as Registered Nurses and promoting EBP as an essential component within academic culture (Du et al., 2023; Sin & Bliquez, 2017). Despite the lack of experience in implementing the EBP skills, nurses and nursing students reported a positive attitude toward using EBP skills (Cardoso et al., 2021; Madhavanprabhakaran et al., 2023). However, some major challenges nursing students face are the lack of support, knowledge, skills, and the opportunity to utilize EBP (Madhavanprabhakaran et al., 2023; Ryan, 2016). Thus, researchers in this field recommended implementing comprehensive, imaginative, and enjoyable teaching methods to promote students' involvement and comprehension of EBP (Madhavanprabhakaran et al., 2023; Kumah et al., 2021; Sin & Bliquez, 2017). Good Behavior Game (GBG), borrowed from applied behaviors analysis and fits this description, can be used as an effective intervention to promote EBP by nursing students.

GBG was first introduced by Barrish et al. (1969) as an interdependent group contingency to address classroom problematic behaviors. Since then, the GBG game has been used to address various academic and behavioral classroom issues. In GBG, the students are assigned into 2 or more groups (Cooper et al., 2019). The groups' performance is gauged against a specific criterion concerning targeted behavior. The groups compete to meet the criterion and gain a reward. According to Cooper and colleagues (2019), the major advantage of the GBG is that the competition can occur within teams, across teams, or against a criterion. While the predominant focus in existing literature has been exploring the utilization of the GBG in school environments to manage disruptive classroom behaviors, there is a noticeable gap in its application within higher education settings to address academic and learning behaviors.

In the present study, the researchers conducted a thorough literature review but there was a scarcity of studies investigating the use of GBG in university, higher education, or professional settings. In their guide for practitioners, Joslyn and colleagues (2020) discussed areas and populations that used GBG in various populations and cited a single study that used GBG in college classrooms. In that study, the authors used GBG to promote participation among college students (Cheatham et al., 2017). In that study, students preferred using GBG to promote their participation over the routine classroom. Thus, the authors concluded that GBG is an effective intervention to improve college students' education. Another study examined the acceptability of an online version of the GBG intervention during the COVID-19 outbreak and found that simulated practice intervention acceptability was increased with the use of the GBG (Perez, 2021). Regardless of the population under examination, it has been reported that the GBG is implemented inequitably among students in the classroom (Reynolds, 2022). Examining and using the GBG as a standard educational approach may help address such variations and biases in applying the GBG. Thus, the current study aimed to investigate the efficacy of implementing the Good Behavior Game (GBG) as a pedagogical intervention to enhance evidence-based practice (EBP) skills among nursing students, thereby contributing to the advancement of innovative teaching methods in nursing education and promoting the integration of EBP within academic settings.

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